“What is coronavirus: Symptoms, how it spreads, how to avoid it - The - The Washington Post” plus 2 more

What is coronavirus: Symptoms, how it spreads, how to avoid it - The - The Washington Post
How Does the Coronavirus Compare to the Flu? - The New York Times
Drug meant for Ebola may also work against coronaviruses: Understanding how drugs work is an important step in developing new treatments for COVID-19 - Science Daily

What is coronavirus: Symptoms, how it spreads, how to avoid it - The - The Washington Post

Posted: 29 Feb 2020 08:06 AM PST

What began with a handful of mysterious illnesses in a vast central China city has traveled the world, jumping from animals to humans and from obscurity to international headlines. First detected on the last day of 2019, the novel coronavirus has infected tens of thousands of people — within China's borders and beyond them — and has killed more than 2,500. It has triggered unprecedented quarantines, stock market upheaval and dangerous conspiracy theories.

Most cases are mild, but health officials say the virus's spread through the United States appears inevitable. As the country and its health-care system prepares, much is still unknown about the virus that causes the disease now named covid-19.

The Washington Post has spoken to scores of doctors, officials and experts to answer as many of your questions as we can about the newest global health emergency. Here's what we know so far.

What is it?

These days, "coronavirus" is often prefaced with the word "novel," because that's precisely what it is: a new strain in a family of viruses we've all seen before — and, in some form, had. According to the WHO, coronaviruses are a large family of viruses that range from the common cold to much more serious diseases. These diseases can infect both humans and animals. The strain that began spreading in Wuhan, the capital of China's Hubei province, is related to two other coronaviruses that have caused major outbreaks in recent years: severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).

Symptoms of a coronavirus infection range in severity from respiratory problems to cases of pneumonia, kidney failure and a buildup of fluid in the lungs.

How deadly is it?

Public health officials say the novel coronavirus is less deadly than SARS, which killed about 10 percent of people who were infected during the outbreak that began in 2002. But epidemiologists are still trying to determine exactly how deadly covid-19 is.

About 2 percent of reported cases have been fatal, but many experts say the death rate could be lower. That's because early in an outbreak, mild illnesses may not be reported. If only people with severe illness — who are more likely to die — seek care, the virus will appear much more deadly than it really is because of all the uncounted people with milder symptoms.

Early in the outbreak, one expert estimated that although 2,000 cases had been reported, 100,000 people probably were sick. Under counting cases can artificially increase the infection's mortality rate.

How does it spread?

Covid-19 spreads more easily than SARS and is similar to other coronaviruses that cause cold-like symptoms, experts have said. It appears to be highly transmissible, and since cases are mild, the disease may be more widespread than current testing numbers suggest.

There have been reports of people transmitting the virus before they show symptoms, but most experts think this is probably not a major driver of new infections. What is concerning, however, is that symptoms can be mild, and the disease can clearly spread before people realize they're sick. SARS spread when people had full-blown illness, which is one reason it was possible to contain it — it was easier to tell who had the virus.

A report in the New England Journal of Medicine suggested covid-19 reaches peak infectiousness shortly after people start to feel sick, spreading in the manner of the flu. A study published in JAMA chronicled the case of a 20-year-old Wuhan woman who appeared to infect five relatives, even though she never showed signs of illness.

Confirmed cases

Who is most at risk of severe illness?

Similar to other respiratory illnesses, older people and those with illnesses such as diabetes and high blood pressure are at increased risk. Early studies have also suggested men are at greater risk.

But, as with other diseases, there can be tremendous individual variation in how people respond. There will be people with known risk factors who recover as well as people who develop severe cases for reasons we don't understand.

"It may be a very specific thing about the way your immune system interacts with a particular pathogen," said Allison McGeer, an infectious-disease epidemiologist at the University of Toronto. "It may also be just about exactly what your exposure is."

What's it like to have covid-19?

Symptoms are primarily respiratory. Coughing and shortness of breath are common, according to the CDC. Fever is also possible. The severity of the symptoms depends highly on the patient's age and immune system.

For the elderly and those with underlying heart disease, diabetes or other conditions, coronavirus can cause pneumonia and lead to organ failure and death. But for most people, cases have been mild, requiring little to no medical intervention.

Carl Goldman, the owner of a California radio station, is one of those people.

"I have the coronavirus," he wrote in an op-ed for The Post. "And it hasn't been that bad."

Goldman, who is in his late 60s, says a bad case of bronchitis a few years ago was much worse.

"This has been much easier: no chills, no body aches," he wrote of coronavirus. "I breathe easily, and I don't have a stuffy nose. My chest feels tight, and I have coughing spells. If I were at home with similar symptoms, I probably would have gone to work as usual."

But Goldman was aboard the Diamond Princess cruise ship, where dozens of Americans were infected.

"If you told me when I left home in January that I wouldn't be back until March — that, instead, I would be confined for more than 24 days because I'd catch a novel virus at the center of what could become a pandemic — that would have completely freaked me out," Goldman wrote. "But now that it's happening, I'm just taking it one day at a time."

Where has it spread?

How should I prepare?

The virus may be novel, but you don't need to buy anything new or special to brace for it. Epidemiology experts said the most important aspect of preparedness costs nothing at all — calm.

"Don't panic," said Timothy Brewer, a professor of epidemiology and medicine at UCLA. "There's no value in panicking or telling people to be afraid. Don't let fear and emotion drive the response to this virus."

There are some basic precautions you can take, which are the same as what you should be doing every day to stave off other respiratory diseases. You've seen the guidance before: Wash your hands regularly. Cover your nose and mouth when you sneeze. And when you're sick, stay home from work or school and drink lots of fluids.

The CDC recommends washing with soap and water for at least 20 seconds after using the bathroom, before eating and after blowing your nose or sneezing. It also advises not to touch your eyes, nose and mouth and to clean objects and surfaces you touch often.

Do I need to wear a mask?

If you're not already sick and you're not a health-care worker, the short answer is no. And you certainly don't need to buy every box your local pharmacy has in stock.

"The main point of the mask is to keep someone who is infected with the virus from spreading it to others," Brewer said.

The CDC agrees, writing on its website: "CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory diseases."

Common surgical masks block the droplets coming out of a sick person from getting into the air, but they are not tight enough to prevent what's already in the air from getting in.

There are specialized masks — known as N95 masks because they filter out 95 percent of airborne particles — that are more effective, and some online retailers are sold out of them. But there's a problem: The masks are difficult to use without training. They must be fitted and tested to work properly.

Read more about those masks here.

What do reports of a patient being 'cured' mean?

There are two kinds of "cured" in an infectious disease context, said Bruce Ribner, a professor at the Emory University School of Medicine.

"Clinically cured" is when someone feels better and stops showing symptoms such as fever and coughing. "Pathogen cured" is when doctors determine the virus is indeed no longer in the body and therefore the patient can't transmit the disease.

The former is clear to a patient. The latter, "we don't yet have a good handle on what it takes," Ribner said.

There's still no antiviral to treat the novel coronavirus. But Todd Ellerin, director of infectious diseases at South Shore Health in Massachusetts, said, "most patients are cured of this on their own" by their immune system fighting the virus, just as with influenza. But for at-risk patients, the novel coronavirus infection can be far more severe.

When will it end?

This coronavirus could follow a seasonal pattern, peaking in the winter months. It could infect lots of people now and then recede in the Northern Hemisphere before returning in the fall. It could take hold in the Southern Hemisphere.

"This virus can do anything it wants," McGeer said. "That pattern of how it's going to spread is completely unknown, but it is critical to what the burden is going to be to all of us. … It could be just like another coronavirus, a bunch of colds. It could be like a regular flu season. It's possible it could be different and worse."

Terms to know

Coronavirus: This term refers to a family of seven known viruses that can infect people, ranging from the common cold to severe acute respiratory syndrome (SARS) and the even deadlier Middle East respiratory syndrome (MERS). The name comes from the virus's shape, which under a microscope looks like a blob surrounded by crown-like spikes.

Covid-19: Sometimes used interchangeably with coronavirus and the official name SARS-CoV-2, covid-19 refers to the disease the virus causes. So SARS-CoV-2 causes covid-19, just as HIV causes AIDS.

Zoonotic: The new coronavirus was transmitted from animals to people, making it zoonotic. SARS came from civets, which are like cats, and MERS came from camels, but it's not yet known what animal caused the current coronavirus outbreak. The prime suspect so far is the pangolin.

Community transmission: This happens when a disease circulates among people in a certain area who did not travel to an affected location and have no close link to other confirmed cases. To date, almost all cases in the United States have been imported by Americans infected abroad or by a spouse or close contact with the virus. But U.S. officials have identified at least one case in California that is being called the first known instance of community transmission.

Asymptomatic transmission: Asymptomatic carriers of the virus are people who show no signs of being sick but have the virus and can spread it to others. It is unclear how common asymptomatic transmissions are with the new coronavirus.

Outbreak: A sudden increase in the number of cases of a disease in a particular place and time.

Epidemic: A large outbreak that spreads among a population or in a region.

Pandemic: An epidemic that has become rampant in multiple countries and continents simultaneously. So far, the World Health Organization has held off declaring the current crisis a pandemic, but many experts think the virus's geographic spread is already at that level or will be before long.

Isolation: Keeping those who are sick and infected away from those who aren't is referred to as isolation. Hospitals have taken strict measures to isolate coronavirus patients using isolation wards, ventilators that prevent air from circulating more widely and heavy protective gear for health workers.

Quarantine: Restricting the movement of people who seem healthy but may have been exposed to the virus is known as a quarantine. Americans who were evacuated from Wuhan and cruise ships, for example, have been kept in strict quarantine on military bases for 14 days, which is what experts believe is the virus's incubation period.

Read more about these terms here.

How Does the Coronavirus Compare to the Flu? - The New York Times

Posted: 29 Feb 2020 11:56 AM PST

Is this new coronavirus really a serious danger? Doesn't the flu kill more people?

As the United States recorded its first coronavirus death on Saturday — and as other cases popped up in people without known risks on the West Coast — Americans wondered how to measure this new threat against a more familiar foe: influenza.

President Trump, a self-described germophobe, said on Wednesday he was amazed to learn that tens of thousands of Americans died from the flu each year, contrasting that number with the 60 or so known to be infected with the coronavirus. On Friday, Mr. Trump accused the news media and Democrats of exaggerating the dangers of the virus.

"The flu kills people," Mick Mulvaney, the acting White House chief of staff, said on Wednesday. "This is not Ebola. It's not SARS, it's not MERS. It's not a death sentence."

To many public health officials, that argument misses the point.

Yes, the flu is terrible — that's exactly why scientists don't want another contagious respiratory disease to take root. If they could stop the seasonal flu, they would. But there may yet be a chance to stop the coronavirus.

In many ways, the flu is the best argument for throwing everything at the coronavirus. Here's a closer look at the similarities and differences.

Which virus is deadlier?

The coronavirus seems to be more deadly than the flu — so far.

On average, seasonal flu strains kill about 0.1 percent of people who become infected. The 1918 flu had an unusually high fatality rate, around 2 percent. Because it was so contagious, that flu killed tens of millions of people.

Early estimates of the coronavirus death rate from Wuhan, China, the epicenter of the outbreak, have been around 2 percent. But a new report on 1,099 cases from many parts of China, published on Friday in The New England Journal of Medicine, finds a lower rate: 1.4 percent.

The coronavirus death rate may be even lower, if — as most experts suspect — there are many mild or symptom-free cases that have not been detected.

The true death rate could turn out to be similar to that of a severe seasonal flu, below 1 percent, according to an editorial published in the journal by Dr. Anthony S. Fauci and Dr. H. Clifford Lane, of the National Institute of Allergy and Infectious Diseases, and Dr. Robert R. Redfield, director of the Centers for Disease Control and Prevention.

But even a disease with a relatively low death rate can take a huge toll if enormous numbers of people catch it. As of Friday, there were 83,861 coronavirus cases and 2,867 deaths. This week, for the first time, the number of new cases outside China exceeded the number within the country.

Which virus is more contagious?

So far, the new coronavirus seems to be more contagious than most strains of the flu, and roughly as contagious as strains that appear in pandemic flu seasons.

Each person with the coronavirus appears to infect 2.2 other people, on average. But the figure is skewed by the fact that the epidemic was not managed well in the beginning, and infections soared in Wuhan and the surrounding province. As an epidemic comes under control, the reproduction number, as it's called, will fall.

Answers to your most common questions:

Updated Feb. 26, 2020
- What is a coronavirus?
  It is a novel virus named for the crownlike spikes that protrude from its surface. The coronavirus can infect both animals and people and can cause a range of respiratory illnesses from the common cold to more dangerous conditions like Severe Acute Respiratory Syndrome, or SARS.
- How do I keep myself and others safe?
  Washing your hands frequently is the most important thing you can do, along with staying at home when you're sick.
- What if I'm traveling?
  The C.D.C. has warned older and at-risk travelers to avoid Japan, Italy and Iran. The agency also has advised against all nonessential travel to South Korea and China.
- Where has the virus spread?
  The virus, which originated in Wuhan, China, has sickened more than 80,000 people in at least 33 countries, including Italy, Iran and South Korea.
- How contagious is the virus?
  According to preliminary research, it seems moderately infectious, similar to SARS, and is probably transmitted through sneezes, coughs and contaminated surfaces. Scientists have estimated that each infected person could spread it to somewhere between 1.5 and 3.5 people without effective containment measures.
- Who is working to contain the virus?
  World Health Organization officials have been working with officials in China, where growth has slowed. But this week, as confirmed cases spiked on two continents, experts warned that the world was not ready for a major outbreak.

By comparison, the figure for the seasonal flu is roughly 1.3. The reproduction number for the flu of 1918 was about the same as that of the new coronavirus, perhaps higher, but that was before modern treatments and vaccines were available.

In both flu and the illness caused by the coronavirus, people may be contagious before symptoms develop, making it difficult or even impossible to control the spread of the virus. Nobody knows how many people infected with the coronavirus have only very mild symptoms or none at all.

Who is most at risk from infection?

Both the coronavirus and influenza are most dangerous to people who are older than 65, or have chronic illnesses or a weak immune system.

Death rates among men infected with the coronavirus in China, particularly those in their late 40s and older, have exceeded those among women, a pattern not seen in the seasonal flu. The reason for the discrepancy is not known, although Chinese men do smoke more, often resulting in compromised lung function.

There seems to be another important difference: The flu appears far more dangerous to children, particularly very young ones, who can become severely ill. Children infected with the new coronavirus tend to have mild or no symptoms.

The flu is also especially dangerous for pregnant women, who can become severely ill from it. Whether the new coronavirus poses as serious a threat to pregnant women is not known.

Which virus makes you sicker?

As of Feb. 22, in the current season there were at least 32 million cases of flu in the United States, 310,000 hospitalizations and 18,000 flu deaths, according to the C.D.C. Hospitalization rates among children and young adults this year have been unusually high.

There would be even more illnesses and deaths if there were no flu vaccine. Most people recover in less than two weeks, and sometimes in just days.

By contrast, fewer than 70 people in the United States have been infected with the new coronavirus, and there has been one death. There are no treatments or vaccines for the coronavirus, only supportive care for infected people.

Most cases of coronavirus infection are not severe, but some people do become quite sick. Data from the largest study of patients to date, conducted in China, suggests that of coronavirus patients receiving medical attention, 80 percent had mild infections, about 15 percent had severe illnesses, and 5 percent were critical.

The first symptoms, fever and cough, are similar to that of the flu, so the diseases can be hard to tell apart without a test to identify the virus. Pneumonia is common among coronavirus patients, even among those whose cases are not severe.

Experts think there may also be many people with no symptoms at all, or such mild ones that they never bother to seek medical attention. Because those cases have not been counted, it's not possible now to know the real proportion of mild versus severe cases.

Antibody tests, which can determine whether someone has ever been infected, may eventually help to establish how many people had mild or asymptomatic coronavirus infections.

Can people become immune to the coronavirus?

After viral infections, people generally develop antibodies in their blood that will fight off the virus and protect them from contracting it again. It's reasonable to assume that people who have had the new coronavirus will become immune to it.

But it is not known how long that immunity will last. With other coronaviruses, which cause the common cold, immunity can wane.

There are vaccines for the seasonal flu, of course, and these induce at least partial immunity to influenza.

What treatments are available?

There is no approved antiviral drug for the coronavirus, though several are being tested. Doctors can recommend only the usual remedies for any viral illness: rest, medicine to reduce pain and fever, and fluids to avoid dehydration.

Coronavirus patients with pneumonia may also need oxygen, and a ventilator if breathing trouble worsens.

For the flu, however, there are four prescription medicines. All work best if they are taken within a day or two of when symptoms start.

They're not miracle cures: They can lessen the severity of the illness and shorten its course by a day or so, and they may lower the risk of serious complications.

The drugs are also recommended for people who have been exposed to a flu patient, to try to prevent the illness.

The flu, like the coronavirus illness, can also cause pneumonia and breathing trouble. Anyone who becomes short of breath needs medical attention quickly.

Can I get vaccinated?

An experimental vaccine for the coronavirus may be ready for testing in humans within a few months, but will take much longer, at least a year or two, to become available for widespread use.

Flu vaccines, on the other hand, are widely available and generally 40 percent to 60 percent effective, which means they will reduce cases by that amount in a population that has been vaccinated, compared with one that has not.

The vaccine for the current season falls into that range, according to the C.D.C., which said on Feb. 21 that people who have not been vaccinated should still get the shot, because the flu season is ongoing.

Experts have been urging people to get the flu shot for all the usual reasons. But now there's another: If there is a coronavirus outbreak in the United States, hospitals will need all the beds, equipment and staff they can muster.

It will be important not to have those resources taken up by patients with flu that could have been prevented.

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Will the coronavirus go away when the weather warms?

Mr. Trump has said repeatedly that the coronavirus will retreat as weather warms, just as influenza does. In fact, because this is a new virus, there is no information about how the weather might affect it.

Even if the virus were to diminish in the spring, it might rebound later in the fall, as the weather cools. This is a pattern often seen in severe flu seasons.

Containment is becoming less likely, because of the contagiousness of the virus, the possibility that people can spread it before they have symptoms and the increasing number of outbreaks around the world.

The cases in California, Oregon and Washington State without known links to overseas travel, reported on Friday, may be a warning sign that the new coronavirus has already begun to circulate.

Reporting was contributed by Gina Kolata and Knvul Sheikh.

Drug meant for Ebola may also work against coronaviruses: Understanding how drugs work is an important step in developing new treatments for COVID-19 - Science Daily

Posted: 27 Feb 2020 04:56 AM PST

A group of University of Alberta researchers who have discovered why the drug remdesivir is effective in treating the coronaviruses that cause Middle East respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS) expect it might also be effective for treating patients infected with the new COVID-19 strain.

"Even if you know a drug works, it can be a red flag if you don't know how it works," said virologist Matthias Götte. "It is reassuring if you know exactly how it works against the target.

"We know the drug works against different coronaviruses, like MERS and SARS, and we know the novel coronavirus is very similar to SARS. So I would say I'm cautiously optimistic that the results our team found with remdesivir and MERS will be similar with COVID-19."

The study, published in the Journal of Biological Chemistry this week, is among the first in Canada to discuss the COVID-19 strain.

Until now, there has not been a published explanation of why remdesivir may work against coronaviruses, said Götte, who added his study is an important step in answering that question.

Developed by Gilead Sciences as a response to the 2014 West African Ebola virus epidemic, remdesivir was first used on a patient with the novel coronavirus earlier this year in the United States.

As reported in the New England Journal of Medicine, the patient was given the drug on the seventh day of illness, and showed marked improvement the following day, with symptoms eventually disappearing altogether. And at a recent press conference in Beijing, the assistant director-general of the World Health Organization, Bruce Alyward, said remdesivir is the only drug available that may have real efficacy against COVID-19.

"What our study showed was that remdesivir essentially mimics one of the natural building blocks for RNA synthesis necessary for genome replication of the virus. Enzymes within the virus are synthesizing the viral RNA genome with these building blocks, but they mix up the bits they need with the drug. Once the drug is incorporated into the growing RNA chain, the virus can no longer replicate,"explained Götte.

He said the next step is to wait for results from ongoing clinical trials with remdesivir, which are expected by the end of April. Even then, that won't be the end of the story, he cautioned.

"It's likely we'll need more than one drug to properly fight emerging diseases like COVID-19, as we have with HIV and hepatitis C virus infections," Götte said.

"Ideally, we will have a couple of drugs because certain strains could be resistant to certain treatments."

Götte's study was supported by grants from the Canadian Institutes of Health Research and the Alberta Ministry of Economic Development, Trade and Tourism through the Major Innovation Fund Program and Antimicrobial Resistance -- One Health Consortium.

Story Source:

Materials provided by University of Alberta Faculty of Medicine & Dentistry. Original written by Ryan O'Byrne. Note: Content may be edited for style and length.

Severe Acute Respiratory Syndrome